MbShea@PWP@English@UMCP

ABSTRACT: In a healthcare system that focuses on treatment, not prevention, monitoring vitamin D level is low priority for the government, insurance companies, physicians, and patients. Hossein-nezhad reports that 32% of the US population is vitamin D deficient (2013). However, increased vitamin D levels can decrease the risk of cancer, neurologic disorders, and a weak immune system. Desai has experienced many cases where vitamin D deficiency and lack of sun exposure were the only risk factors in patients with brain cancer, fall-related fractures, and multiple sclerosis (2015). Additionally, decades of research support the various benefits of vitamin D. Vitamin deficiency and the associated health detriments are most common in patients with dark skin pigmentation because of the sunlight-dependent vitamin D production in human skin. Liu connected low vitamin D levels in African Americans to low antimicrobial function of macrophages (2006). Similarly, individuals living further from the equator absorb significantly less sunlight that leads to vitamin D production. Apperly discovered that populations further from the equator have up to 150% higher risk of cancer than those living near the equator (1941). Vitamin D influences many areas of human health because vitamin D receptors are located in most human tissues; Ramagopalan identified 2776 vitamin D binding sites in the human genome (2010). Increased research, clinical application, and patient education could lead to insurance coverage of vitamin D screening and greater support for vitamin D supplementation. These preventative measures can significantly decrease the rate of detrimental health conditions in the general population.

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READER’S PROFILE: I imagine a reader who has different theories about vitamin D, especially physicians and researchers who believe in evidence rejecting the importance of vitamin D. Dr. Ravi Thadhani, a professor of medicine at Massachusetts General Hospital, is an example of this type of reader.

READER’S RESPONSE: This author cites many examples of diseases and disorders that are associated to vitamin D deficiency. The author accumulates a high quantity of sources, but I think the results that he found are mostly correlational. While vitamin D deficiency could be the causative factor to all these health conditions, many confounding factors could exist when the evidence is only based on correlations. From my research, I found that the amount of vitamin D binding sites in African Americans are much lower than the amount found in lighter skin populations. While considering that the African American population has the best bone health, I truly believe that the effect of vitamin D on bone health is questionable, especially in African American populations. Holes in the current theory of vitamin D, like the one I’ve identified, could also exist in vitamin studies focused on cancer, neurologic disorders, and the immune system. I do agree that we need more support in the field of vitamin D research to fully understand the effects of vitamin D. However, at the same time, you have not persuaded me to support your pro-vitamin D stance because of the smaller sample sizes and the contradicting results of current vitamin D studies.

I -- I am glad that you are working on a clinical challenge with some emerging consensus that is also countered by a pretty compelling counter argument. You do not really need to solve the problem BUT help physicians see the "stasis" of the argument; in other words, where the argument now rests:

stasis of practical/causality PLUS stasis of value (good, neutral, harm).